The Journal of Contemporary Dental Practice

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Volume 21, Number 12, December 2020


Gargi S Sarode, Sachin C Sarode, Amol R Gadbail, Shailesh Gondivkar, Nilesh K Sharma, Shankargouda Patil

Angiotensin-converting Enzyme 2 Specific Cell Subset Identification in Oral Tissues: A Need of the Hour in COVID-19 Research

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:2] [Pages No:1305 - 1306]

PDF  |  DOI: 10.5005/jp-journals-10024-2943  |  Open Access |  How to cite  | 


Marc Sher, Riaan Mulder

Comparison of Aerosolized Hydrogen Peroxide Fogging with a Conventional Disinfection Product for a Dental Surgery

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1307 - 1311]

Keywords: Colony-forming units, Dental surgery, Fogger, Hydrogen peroxide vapor, Surface disinfectant

PDF  |  DOI: 10.5005/jp-journals-10024-2983  |  Open Access |  How to cite  | 


Aim and objective: The study aimed to determine the efficacy of adding a 12% hydrogen peroxide dry hydrogen peroxide vapor fogger system as an additional layer of infection control in a dental surgery. Materials and methods: A total number of agar plates from the five locations were used during the treatment of the 22 patients (n = 440). During the treatment of each patient, four agar plates (n = 4) were used per location [location 1: X-ray, location 2: the dental arm, location 3: left side desk, location 4: under the foot of the dental chair, location 5: right side desk and (n = 20 for the five locations per patient)]. The control agar plates were incubated after the treatment of the patient was completed period. The test agar plate groups were sprayed with a 70% isopropanol surface disinfectant, or received exposure to an automated 12% hydrogen peroxide fog, or a 70% isopropanol surface disinfectant spray immediately followed by exposure to the automated 12% hydrogen peroxide. Results: One-way ANOVA and Scheffé\'s method identified significant differences (p < 0.01). Between the control agar plates and the three disinfection methods used a significantly lower colony count was established for colonies recorded in the surgery assessed as a whole, the X-ray unit, and the right side desk. Conclusion: The disinfection of dental surgery requires sufficient time as it not only includes the working surfaces but also various inanimate objects. Surface disinfectant spray followed by hydrogen peroxide decontamination has potential for dental surgery, as the colony-forming units have been reduced further compared to spray alone and even just fog alone for all the various areas of the dental surgery that was assessed. Clinical significance: The infection control protocols with hydrogen peroxide vapor would ensure the maximum efficacy of the disinfection protocols.


Arief Johanes, Retno Widayati, Nurtami Soedarsono, Benny M Soegiharto

Correlation between Pain Perception and CGRP Expression during Initial Tooth Alignment Using either a Self-ligating or a Pre-adjusted Bracket System

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:4] [Pages No:1312 - 1315]

Keywords: Cohort study, Orthodontic tooth movement, Pain, Passive self-ligating, Pre-adjusted,Calcitonin gene-related peptide

PDF  |  DOI: 10.5005/jp-journals-10024-2947  |  Open Access |  How to cite  | 


Aim and objective: Orthodontic tooth movement (OTM) occurs when the force applied to the tooth stimulates inflammation and alveolar bone remodeling. Less friction is produced by passive self-ligating (PSL) brackets compared to pre-adjusted edgewise (PE) brackets; therefore, PSL bracket use is thought to result in less pain than the use of PE brackets. The neuropeptide calcitonin gene-related peptide (CGRP), isolated from gingival crevicular fluid (GCF), can be used as a pain biomarker for OTM. Pain perception can be subjectively evaluated using the visual analog scale (VAS). This study aimed to analyze pain perception, using the VAS and CGRP levels, and to examine the correlation between VAS scores and CGRP levels. Materials and methods: A total of 15 patients were included in this study (a PSL group, a PE group, and a control group). GCF was collected from the lower anterior teeth, at interproximal sites, before bracket insertion and 2 hours, 24 hours, and 168 hours after lower archwire engagement. Pain perception was recorded using the VAS. CGRP concentrations were analyzed using an enzyme-linked immunosorbent assay (ELISA). Results: The VAS scores of the PE and PSL groups increased 2 hours after archwire engagement, peaked after 24 hours, and returned to baseline after 168 hours, and the PE group had high scores than the PSL group, with the highest score being recorded at the 24 hour time point. CGRP concentrations were also the highest at the 24 hour time point compared to the other time points. Conclusion: These results showed that both the VAS score and the CGRP concentration increased during initial orthodontic tooth alignment when using either the PSL or the PE bracket systems. Pain perception scores and CGRP concentrations were weakly positively correlated. Clinical significance: The type of bracket system used influenced the patients’ pain perception scores and the release of CGRP.


Dina Kamal, Hassan Hassanein, Mai Akah, Mostafa A Abdelkawy, Heba Hamza

Caries Preventive and Antibacterial Effects of Two Natural Mouthwashes vs Chlorhexidine in High Caries-risk Patients: A Randomized Clinical Trial

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:9] [Pages No:1316 - 1324]

Keywords: Licorice, Natural mouthwashes, Oral side effects, Randomized clinical trial,Antibacterial effect, Caries preventive effect, Gum Arabic

PDF  |  DOI: 10.5005/jp-journals-10024-2986  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the caries preventive and antibacterial effects of Gum Arabic and Licorice mouthwashes vs chlorhexidine in high caries-risk patients. The prevalence of oral side effects from using the mouthwashes was also assessed. Materials and methods: Total 63 participants categorized as high caries-risk according to the CAMBRA caries-risk model were recruited. They were randomly allocated to three groups (n = 21) according to the mouthwash used: G1 (Gum Arabic), G2 (Licorice), and G3 (Chlorhexidine). Baseline DMF scores and saliva samples were obtained. DMF scores, salivary Streptococcus mutans (SM) and Lactobacillus acidophilus (LA) counts, and any reported oral side effects were recorded after 3, 6, 9, and 12 months. The obtained results were subjected to the statistical analysis and the significance level was set at p ≤ 0.05. Results: Regarding DMF scores, no statistically significant difference was found between the three groups at baseline, after 3, 6, and 9 months. After 12 months, a statistically significant difference was found between G3 and each of G1 and G2 where G3 showed significantly higher DMF scores (p < 0.001). No statistically significant difference was found between G1 and G2. Regarding antibacterial activity, after 6 months, all mouthwashes showed statistically significant antibacterial effect against SM and LA with no statistically significant difference between them (p < 0.001). After 9 and 12 months, G1 and G2 showed a statistically significant reduction in SM and LA counts (p < 0.001). However, G3 showed a statistically significant increase in SM and LA counts indicating bacterial resistance (p < 0.001). No oral side effects were reported in G1 and G2. On the other hand, several oral side effects were reported in G3. Conclusion: Gum Arabic and Licorice mouthwashes show promising caries preventive and antibacterial effects with no oral side effects reported. Clinical significance: Natural mouthwashes can serve as substitutes to chemical agents as chlorhexidine, providing effective caries control and safe long-term use.


Sudhakar Srinivasan, Gayathri Velusamy, Meer Ahamed Ibrahim Munshi, Karthikeyan Radhakrishnan, Rahul Vinay Chandra Tiwari

Comparative Study of Antifungal Efficacy of Various Endodontic Irrigants with and without Clotrimazole in Extracted Teeth Inoculated with Candida albicans

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:6] [Pages No:1325 - 1330]

Keywords: Sodium hypochlorite,Chlorhexidine, Clotrimazole, Doxycycline, Endodontic irrigants

PDF  |  DOI: 10.5005/jp-journals-10024-2939  |  Open Access |  How to cite  | 


Aim and objective: To assess the application of clotrimazole (1%) as a complementary antifungal agent along with sodium hypochlorite (5.25%), chlorhexidine gluconate (2%), and doxycycline hydrochloride (5%) against Candida albicans. Materials and methods: Seventy freshly extracted single-rooted premolars with matured apices were collected, stored, and handled according to the Occupational Safety and Health Administration (OSHA) and the Center for Disease Control and Prevention (CDC) guidelines and recommendations. These were divided into three groups (two tests and one control group) depending on irrigants used. The efficacy of each irrigant group was compared. The observations were statistically analyzed by the multiple intergroup comparisons using ANOVA and Scheffe multiple comparisons (p < 0.001). Results: The sodium hypochlorite (group IA—mean 129.6) has shown a statistically significant decrease in colony-forming units (CFUs) (p < 0.01) on comparison with chlorhexidine [(IB) mean 190.2]. A similar result was obtained in comparison with the sodium hypochlorite group (IA) and doxycycline HCl group [(IC) mean 318.4] and also between the sodium hypochlorite group (IA) and the control group [(III) mean 554.2]. The intragroup comparison of group II, group IIA (mean 63.3), and group IIB (mean 73.8) showed no statistically significant difference. Group III (mean 554.2) was the least effective of all the subgroups. Conclusion: Sodium hypochlorite showed better antifungal efficacy than chlorhexidine and doxycycline when used alone. The addition of clotrimazole increased the efficiency of doxycycline also, but it was less compared to sodium hypochlorite and chlorhexidine. Within the limitations of this study, the inclusion of 1% clotrimazole increased the antifungal efficacy of all the three irrigants. Clinical significance: Our study compared the efficacy of the various endodontic irrigants and also determined their efficiency with the addition of the antifungal agent. Clotrimazole (1%) addition in irrigating solutions showed better results and promoted faster healing.


Alla T Alsharif, Bashair Alsharif, Lina Alsharif, Nebras Althagafi, Zuhair S Natto, Saba Kassim

Effectiveness of WhatsApp as a Part of a Hybrid Learning Environment: An Opportunity for Post-COVID-19 Pandemic Pedagogy

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:6] [Pages No:1331 - 1336]

Keywords: Dental Epidemiology, Education, Hybrid Learning, Interventional Study, WhatsApp

PDF  |  DOI: 10.5005/jp-journals-10024-2978  |  Open Access |  How to cite  | 


Aim and objective: This study sought to examine the effectiveness of hybrid learning utilizing WhatsApp as an adjunct to traditional learning in delivering knowledge to and supporting the learning of undergraduate dental students and investigate learner perceptions of WhatsApp use in educational contexts. Materials and methods: The 3-month prospective analytical interventional study sampled 85 undergraduate students from the Department of Preventive Dental Sciences. A WhatsApp group was created, information was sent to the male and female groups, and a written assignment was used as a performance benchmark of knowledge acquisition and application. Perceptions of e-learning through WhatsApp were assessed using a previously validated and published questionnaire. Collected data underwent descriptive and bivariate analyses (unpaired t-test). Results: The average assignment scores of the 85 hybrid learners were statistically significantly higher than those of traditional learners from the previous academic year (34 ± 1 vs 26 ± 3; p < 0.05, respectively). Meanwhile, 57 hybrid learners completed the survey, and 73% agreed/strongly agreed that introducing a new method of teaching via WhatsApp was useful, 70% reported that a professional and comfortable learning environment was created, and 70% felt that group distractions were handled appropriately. The top advantages of learning through WhatsApp were availability/immediacy (94.7%) and being simple to operate (91.2%). Males (40.4%) were significantly more likely to report a sense of belonging to the group than females (33.3%, p = 0.01). Respondents agreed that high expectations of teacher availability (71.9%) and some students making no effort (52.6%) were challenges. Message flooding (45.6%) and time-consuming nature of WhatsApp (36.8%) were identified as technical challenges. Conclusion: The findings showed significant improvements in student performance using the hybrid learning tool, as reflected in assignment scores. Positive perceptions of hybrid learning and improved academic performance indicate that WhatsApp is a convenient new teaching tool. Clinical significance: The results of this study may be applicable to other clinical dental disciplines.


Rashtra Bhushan, Pavithra K Ramanna, Senthil Kumar, Radhika Thakkar, Parthivi Singh, Mukta Nigam

Impact of Fluoridated and Non-fluoridated Mouth Rinses on Frictional Resistance between Orthodontic Archwire and Bracket: A Comparative Study

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1337 - 1341]

Keywords: Orthodontic bracket, Surface roughness,Archwire, Frictional resistance

PDF  |  DOI: 10.5005/jp-journals-10024-2944  |  Open Access |  How to cite  | 


Aim and objective: The present study aimed to assess the effect of fluoridated and nonfluoridated mouth rinses on resistance to friction between orthodontic bracket and archwire. Materials and methods: This study comprises 60 premolar stainless steel (SS) brackets with 0.022 inches slot size. The 0.019 × 0.025 dimensions SS archwires were cut into 5 cm long specimens. They were grouped into three main categories, group I: artificial saliva (control solution), group II: Aloe Dent mouthwash (ALO), and group III: 0.05% sodium fluoride mouthwash. The specimens from each group were either immersed in the test solution or in the control solution for 10 hours. Later, the specimens were transferred to an incubator maintained at 37°C. Post 10 hours, the specimens were immersed for 30 minutes in distilled water. A scanning electron microscope was used to study the surface morphology and a universal testing machine was used to measure the frictional resistance. Results: The distribution of normality for three study groups’ recorded data was checked using Shapiro–Wilk test. The highest frictional resistance (1.94 ± 0.02) was demonstrated by specimens immersed in 0.05% sodium fluoride mouthwash than those immersed in Aloe Dent mouthwash (1.28 ± 0.66) and artificial saliva (1.10 ± 0.32). The difference found between the groups by an analysis of covariance was statistically significant. The highest surface roughness (22.30 ± 0.12) was revealed by specimens immersed in 0.05% sodium fluoride mouthwash than those immersed in Aloe Dent mouthwash (18.28 ± 0.26) and artificial saliva (15.86 ± 0.42). A statistically significant difference between the groups was shown by an analysis of covariance. Conclusion: After considering the drawbacks of this study, we conclude that specimens immersed in Aloe Dent mouthwash demonstrated less frictional resistance and surface roughness when compared to those immersed in 0.05% sodium fluoride mouthwash. Clinical significance: During sliding mechanism, the frictional resistance between orthodontic archwire and brackets imposes problems, such as lessening the applied force and movement of tooth, and also results in anchorage loss. So, orthodontists should always take care while prescribing mouthwashes to reduce their effects on the friction.


Samah Saker, Danya Hashem

Influence of Surface Modification Protocol and Type of Luting Cement on Bonding of Monolithic Zirconia to Dentin Substrate

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:8] [Pages No:1342 - 1349]

Keywords: Bonding, Cement, Ceramic primer monolithic zirconia, Selective infiltration etching

PDF  |  DOI: 10.5005/jp-journals-10024-2984  |  Open Access |  How to cite  | 


Aim and objective: To assess microtensile bond strength (μTBS) of two types of luting cement to monolithic zirconia and dentin following various surface modifications and aging. Materials and methods: Monolithic zirconia blocks were divided into four main groups. Group N: no surface modification; Group SB: sandblasted using 50 μm Al2O3 particles. Group GH: glazed with a thin film of low-fusing porcelain glaze and etched with 10% hydrofluoric acid for 60 seconds. Group CJ: sandblasted with CoJet sand. Surface-treated ceramic blocks were bonded to dentin using either self-adhesive cement or resin-modified glass ionomer cement and submitted to 3 or 150 days of water storage protocol with aging. The specimens were subjected to tensile force until de-bonding. Surface roughness (Ra, μm) was assessed after surface treatment. Analysis of variance (ANOVA) tests followed by Tukey\'s tests were used to analyze the data (α = 0.05). Results: Surface modification using selective infiltration etching (SIE) showed significantly higher μTBS (p < 0.05) compared to tribochemical silica coating, sandblasting, and no treatment groups. The surface roughness of the SB and CJ groups were statistically higher compared to GH and N groups. Conclusion: Selective glass infiltration etching was an effective method in altering the surface properties, creating a strong and durable bond to monolithic zirconia. Clinical significance: Surface treatment procedures using SIE techniques combined with the use of universal 10-Methacryloyloxydecyl dihydrogen phosphate (MDP)-containing adhesives could establish a long-lasting and strong bonding to monolithic zirconia restorations. Resin-modified glass-ionomer cement (RMGIC) is an alternative luting cement for monolithic zirconia based on the assessment of its bond strength and bond durability.


Nathan Anderson, Adam Lords, Ronald Laux, Wendy Woodall, Neamat Hassan Abubakr

Retrospective Analysis of the Risk Factors of Peri-implantitis

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:4] [Pages No:1350 - 1353]

Keywords: Periodontitis, Respiratory diseases,Dental implant, Peri-implantitis

PDF  |  DOI: 10.5005/jp-journals-10024-2973  |  Open Access |  How to cite  | 


Aim and objective: Peri-implantitis is a key concern for dental implants and the main common reason for implant failure. This investigation evaluated the risk factors and their implications on peri-implantitis. Materials and methods: A retrospective search of the patients’ clinical notes was performed to identify the documented cases of peri-implantitis. The inclusion criteria encompassed patients who were 18 years and older and were seen at the School of Dental Medicine, University of Nevada, Las Vegas, from January 2014 through September 2018. The search revealed that the number of peri-implantitis cases was 28, with an overall 45 implants. Data were collected and analyzed using the Chi-square test. Results: Total 28 patients presented with peri-implantitis. The distribution of males to females with peri-implantitis was 60.7 and 39.3%, respectively. The highest number of patients (21.4%) presenting with peri-implantitis fell within the age range of 65–69 years; 53.3% of peri-implantitis cases were in the maxillary arch. The predilection area for peri-implantitis was the mandibular first molar (24.4%). Periodontitis was the most significant cause (60.7%); respiratory diseases (42.9%) followed by hypertension (28.6%) were the most prevalent medical conditions in the studied population. Peri-implantitis occurred most frequently among Caucasians (62.7%), followed by Hispanics (29%). Conclusion: Within the limitations of the current evaluation, findings support previous claims that periodontitis remains the strongest predictor of peri-implantitis. A correlation may exist between peri-implantitis and the location of the implant and respiratory disease. Clinical significance: The implant location, the presence of periodontitis, and respiratory diseases are considered to be risk factors for peri-implantitis.


Pankaj K Singh, Nikita Raman, Vaibhav K Singh, Saifullah Akhtar, Prabhat Mishra, Sunny Sharma

Cone-beam Computed Tomographic Evaluation of the Anatomical Changes of Temporomandibular Joint Use of Pre-post Dentures: A Time-control Study

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:7] [Pages No:1354 - 1360]

Keywords: Articular eminence, Computed tomography, Glenoid fossa, Temporomandibular joint

PDF  |  DOI: 10.5005/jp-journals-10024-2987  |  Open Access |  How to cite  | 


Aim and objective: The growth of the temporomandibular joint (TMJ) gets affected by multiple factors like aging, occlusion state, and by the movement of the jaw while masticating and swallowing. Radiographic imaging is often utilized as a vital diagnostic adjunct in the evaluation of certain examinations of the TMJ. Materials and methods: In this in vivo study, 30 male participants with mean age 55 years, having edentulous maxillary and mandibular arches from the Outpatient Department of Prosthodontics, were randomly selected. Group I (n = 30) patients who were edentulous for the last 4–5 years but without wearing dentures. Whereas group II (n = 30) patients who were edentulous for the last 4–5 years but were wearing dentures for this period. Maxillary and mandibular dentures were fabricated and delivered to subjects. Subjects were subjected to the TMJ analysis with the help of CBCT. Radiological images of dentomaxillofacial structures were analyzed by a specialist with a dual monitor inside a darkened silent room. On the monitor, three times measurements were recorded followed by calculation of mean value. The recordings were taken on both sides and thus, 210 sites were analyzed altogether, followed by the statistical analysis using SPSS software version 15.0. Results: The mean ages of group I and II were 59.00 ± 6.74 and 58.27 ± 6.75 years, respectively. The intra- and intergroup comparisons were done using a one-sample t-test. Differences in mean intercondylar width in groups I and II were not found to be statistically significant. The difference in mean length of glenoid fossa was not statistically significant at any of the above observation periods. A continuous decline in mean length of glenoid fossa was observed with time in both groups. The range of change in articular eminence length was found to be statistically significant for both the groups (p < 0.05). Conclusion: This study shows that the articular eminence flattening is correlated with age; on the other hand, the rate of deformation was found significantly more in total edentulous subjects as compared to subjects having normally maintained occlusion. The anatomical changes inside the TMJ have been much greater expressed within the completely edentulous subjects in whom the angle of sagittal condyle path declines and so does the articular eminence height. Clinical significance: It is essential to provide the edentulous patient with early prosthetic and occlusal rehabilitation after extractions to prevent the anatomical changes in TMJ.


Osama M Felemban, Cheen Y Loo, Aruna Ramesh

Accuracy of Cone-beam Computed Tomography and Extraoral Bitewings Compared to Intraoral Bitewings in Detection of Interproximal Caries

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:7] [Pages No:1361 - 1367]

Keywords: Dental caries, Dental digital radiography, Extraoral Bitewings, Interproximal caries, Intraoral bitewings,Cone-beam computed tomography diagnostic accuracy, Cone-beam computed tomography

PDF  |  DOI: 10.5005/jp-journals-10024-2979  |  Open Access |  How to cite  | 


Aim and objective: The purpose of this study is to evaluate the diagnostic accuracy of cone-beam computed tomography (CBCT) and extraoral bitewings in the detection of interproximal caries compared to intraoral bitewings. Materials and methods: Seven preserved cadaver heads with 106 teeth (molars, premolars, and canines) including 183 proximal surfaces were used. Five radiographic modalities were studied: intraoral bitewings, extraoral bitewings, iCAT 3D, ProMax 3D high resolution, and ProMax 3D low resolution. Seven pediatric dental residents were recruited and calibrated as observers and asked to evaluate each proximal surface. Teeth were extracted, mounted, drilled, caries detection dye was applied, and the surfaces were examined under the light microscope. Interexaminer reliability, sensitivity, specificity, and area under the curve values were compared. Results: No significant differences were found in sensitivity, specificity, and area under the curve values between the five radiographic modalities. Restorations may influence the accuracy of caries diagnosis. Conclusion: Cone-beam computed tomography radiographs and extraoral bitewings showed similar accuracies in detecting interproximal caries compared to intraoral bitewings. This suggests that with proper training and experience, CBCT and extraoral bitewings could be comparable to intraoral bitewings in detecting interproximal caries. Clinical significance: Cone-beam computed tomography and extraoral bitewings could potentially serve as alternatives to intraoral bitewings to diagnose proximal caries, especially when the CBCT study is needed for a specific diagnostic purpose.


Nandini Biradar, Keerti S Allappanavar, Nithin K Shetty, Basanagouda S Patil, Reshma S Hegde, Prashant Moogi

Evaluation of Marginal Adaptation of Composite Restorations Reinforced with Novel Enamel Inserts (Biofillers) in Class V Cavities

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:6] [Pages No:1368 - 1373]

Keywords: Microleakage,Biofillers, Enamel inserts, Megafillers polymerization shrinkage

PDF  |  DOI: 10.5005/jp-journals-10024-2964  |  Open Access |  How to cite  | 


Aim and objective: To evaluate the marginal adaptation at the tooth-restoration interface at enamel and cementum margins using composite restoration reinforced with novel enamel inserts/biofillers. Materials and methods: Standardized class V box-shaped cavities were prepared in 40 extracted maxillary first premolar teeth which were divided randomly into four experimental groups consisting of 10 samples each. Group I: Bulk placement. Groups II: Horizontal incremental technique. Group III: Restoration with precured composite balls (megafillers). Group IV: Restoration with biofillers. All the cavities were restored with visible light-activated direct restorative nanocomposite. The specimens were thermocycled for 24 hours. After thermocycling, the samples were immersed in a 1% methylene blue for 4 hours and subsequently evaluated for microleakage. Microleakage scores (0–4) were obtained from gingival margins of class V restorations and analyzed by statistical analysis. Evaluation of the data was performed by Kruskal–Wallis one-way analysis of variance (ANOVA), and Mann–Whitney U tests. Results: Microleakage scores have indicated restorations with biofillers showed best results followed by megafillers, incremental horizontal build-up, and bulk filling. Conclusion: Biofillers provide a novel approach in improving microleakage and marginal adaptability of composite resin restorations. Clinical significance: Incorporation of inserts, which are capable of adequate bonding to resin and tooth, may provide improved marginal adaptability and reduce microleakage around restorative margins.


Valentina Spicciarelli, Crystal Marruganti, Marco Martignoni, Ludovica Andreatti, Tiziana Doldo, Marco Ferrari, Simone Grandini

Different Post Placement Strategies for the Restoration of Endodontically Treated Maxillary Premolars with Two Roots: Single Post vs Double Post

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1374 - 1378]

Keywords: Double-post, Fracture strength, Laboratory research, Post-endodontic restoration, Single-post

PDF  |  DOI: 10.5005/jp-journals-10024-2980  |  Open Access |  How to cite  | 


Aim and objective: The present study compared the fracture strength and failure pattern of endodontically treated, bi-rooted, maxillary premolars with different number of coronal walls and postendodontic restoration (one vs double post). Materials and methods: 105 premolars were divided into 3 groups according to the number of residual walls: control group (intact teeth; n = 15), group 1 (3 residual walls; n = 45), group 2 (2 residual walls; n = 45). Each test group was then divided into 3 subgroups (n = 15 each) according to postendodontic restoration: no post (A), 1 post (B) or 2 posts (C). A load was applied parallel to the longitudinal axis of the teeth, thus simulating physiological occlusion. ANOVA and Tukey\'s tests were used to detect fracture strength differences among groups, while Chi-square test was used to check differences in fracture pattern. Results: No significant differences were observed between control group (intact teeth) and groups A1 (p = 0.999), B1 (p = 0.997) and C1 (p = 1.000); statistically significant differences were detected between control group and groups A2 (p < 0.001), B2 (p < 0.001) and C2 (p < 0.05). Different post placement techniques were non-significantly associated with fracture pattern in both groups 1 (p = 0.666) and 2 (p = 0.143) while, irrespective of the number of posts, the presence of the post was significantly associated with the fracture pattern in teeth with two residual walls. The double-post technique did not further improve the fracture resistance of hardly damaged endodontically treated maxillary bi-rooted premolars compared to single-post technique. Therefore, the insertion of a single post in the palatal canal could be a safer and more conservative choice. Clinical significance: The double-post technique did not further improve the fracture resistance of severely structurally compromised endodontically treated maxillary premolars with two roots compared to the single-post technique. Therefore, the safer and less invasive treatment is the placement of a single post in the palatal canal.


Sabari Murugesan, Arasappan Rajakumaran, Buggaveeti Pradeep Kumar, Arumugam Balatandayoudam, Purushotham Mohankumar, N Bharath Naga Reddy

Comparative Evaluation of the Efficacy of Novel Root Canal Irrigation Techniques on Reduction of Enterococcus faecalis Count: An In Vitro Study

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1379 - 1383]

Keywords: Endovac,Dynamic irrigation needle irrigation, E. faecalis endoactivator

PDF  |  DOI: 10.5005/jp-journals-10024-2966  |  Open Access |  How to cite  | 


Aim and objective: To compare the effectiveness of three irrigation systems, namely, Endovac system, Max I probe, and Navitip FX, in reduction of Enterococcus faecalis population from the root canal using agar diffusion method. Materials and methods: Fifty-five extracted intact human permanent maxillary anterior teeth were selected for this study. In group I, root canals were irrigated using brush covered 30-gauge NaviTipFX. Ultradent in group II root canals was irrigated using brush covered 30-gauge Max-I-Probe Dentsply. In group III, root canals were irrigated using Endoactivator, Dentsply. In group IV, root canal was irrigated by using the Endovac system Sybronendo. The steps followed in the study include preparation of specimen, contamination of the samples followed by conduction of testing procedures with implementation of appropriate irrigation protocols, and sampling procedures. Results: Data were subjected to statistical analysis to interpret the significant differences among various irrigation systems. One-way analysis of variance, Post hoc Tukey tests were used for statistical analysis in the present study. Among the experimental groups, group IV showed statistically significant difference in reduction of E. faecalis. There were no statistical differences between them in reduction of E. faecalis in group I and group II compared and represented in Tables 1 and 2. Conclusion: All four irrigation delivery systems have been found to be effective in the reduction of E. faecalis. Endovac showed comparable efficacy in reduction of colony-forming units to that of other delivery systems used in the study. The result has to be validated with in vivo studies and clinical trials of larger sample size. Clinical significance: Selection of appropriate irrigation system capable of disinfection of canal complexities in apical third with less adverse effects is essential for good clinical success of endodontic treatment.


Ghassan Masri, Rola Mortada, Kinda Hatoum, Nawal Al Harbi, Paul Boulos, Ziad Salameh

Evaluation of the Adaptation of Complete Dentures Fabricated Using Intraoral Scanning and Conventional Techniques

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1384 - 1388]

Keywords: Adaptation, Complete denture base, Conventional impression, Intraoral scanning

PDF  |  DOI: 10.5005/jp-journals-10024-2977  |  Open Access |  How to cite  | 


Aim and objective: This study aimed to digitally analyze the 3-dimensional variations existing between conventional impressions and intraoral scans made in edentulous maxillae. Materials and methods: Ten (n = 10) edentulous maxillae of patients seeking a maxillary complete denture were scanned using an intraoral scanner. The same participants were subject to the conventional impression procedure for the fabrication of maxillary complete dentures. The dentures’ intaglio surfaces were scanned and superimposed over their corresponding IOS files with a 2-base best-fit alignment. Deviation analyses were calculated using the digital subtraction technique. Four anatomical regions were preselected to evaluate the deviations at these sites (posterior palatal seal, anterior border seal, the crest of the ridge and palate). Results: Based on the results and color maps of all selected regions, the overall difference between the two scans [IOS and denture intaglio surface scanning (DISS)] was not significant. The IOS technique allowed for predictable outcomes of treatment compared to those observed with conventional impression. The palatal area seems to be the region with the least deviation, while the highest incidence of discrepancy was reported in the anterior border seal. Conclusion: Within the limitations of this study, the IOS technique allowed the capturing of intraoral tissues and their immediate interpretation and transfer to a designing software making the impression procedure faster and easier. Clinical significance: The computer-aided design (CAD)/computer-aided manufacturing (CAM) technologies can help overcome many limitations related to conventional impressions and therefore should be well investigated to improve the edentulous patient\'s quality of life.


Kaushik Haridas, Madhu Hariharan, Prabath Singh, Anju Varughese, Arjun B Ravi, Krishnan Venugopal

Comparative Evaluation of Microcrack Formation in Different Kinematics Using Rotary and Reciprocating File Systems: An In Vitro Study

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:4] [Pages No:1389 - 1392]

Keywords: Reciprocation, Waveone gold,Dentinal microcrack, Kinematics, ProTaper Next

PDF  |  DOI: 10.5005/jp-journals-10024-2981  |  Open Access |  How to cite  | 


Aim and objective: To compare root microcrack formation after root canal preparation using ProTaper Next in rotation or forward reciprocation and Waveone gold in reverse reciprocating motion. Materials and methods: Buccal roots of 60 maxillary premolars with mature apices were selected, for different instrumentation techniques and divided into three groups. Coronal access was achieved and the canals were confirmed for apical patency. The canals were then instrumented using the following instrumentation techniques: ProTaper Next in rotation or forward reciprocation or Waveone gold in reverse reciprocation. The tooth was then subjected to sectioning using a diamond saw under water cooling and then was visualized under the stereomicroscope for dentinal microcrack. Results: The results showed that the maximum dentinal microcrack formed at apical 3 and 6 mm was in Waveone gold in reverse reciprocation followed by ProTaper Next in forward reciprocation and rotation. However, the p value was found to be not significant at 3 and 6 mm (p value—0.082 and 0.23). Conclusion: Nickle titanium rotary instruments tend to induce varied degrees of root dentinal damage during canal instrumentation. ProTaper Next files in rotation as well as forward reciprocation presented with minimal microcrack defects when compared with Waveone gold. Clinical significance: Root canal preparation, when performed by manual or engine-driven techniques, has shown to produce structural defects in the root dentin. One of the causes of failures in root canal treatment is because of fracture in the dentin that occurs due to these procedures. Though all the motion kinematics caused microcracks in this study, it was seen that rotational motion produced the least structural damage to the dentin.


Jesus Creagh, Lauren Bohner, Newton Sesma, Christian Coachman

Integrating a Facially Driven Treatment Planning to the Digital Workflow for Rehabilitation of Edentulous Arches: A Case Report

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:5] [Pages No:1393 - 1397]

Keywords: Computer-aided design, Computer-aided manufacturing, Computer-assisted, Dental implants, Surgery

PDF  |  DOI: 10.5005/jp-journals-10024-2985  |  Open Access |  How to cite  | 


Aim and objective: This case report presents the integration of a digital facially driven prosthetic plan to the computer-assisted implant planning for rehabilitation of edentulous arches. Background: Diagnosis of edentulous arches is hampered by the lack of intraoral references. However, a digital facial profile analysis facilitates the treatment plan, taking into consideration the harmony among teeth, lips, and face to restore a pleasant smile. Case description: The first appointment consisted of digital documentation including intraoral scans, facial scans, and photographs. Based on these data, a smile frame was created to guide the digital wax-up. Cone-beam computed tomography (CBCT) scans were merged to facial and intraoral scans to perform the virtual surgical planning. Integration between facial, intraoral, and bone tissues were used as a reference to define implant position and prosthetic planning. The digital planning was integrated into the surgical procedure using stackable templates, and an immediate loading was performed. The interim prosthesis was manufactured based on the digital wax-up. With digital data, quality control could be performed to evaluate the esthetic outcome of the treatment. Conclusion: An esthetic and functional rehabilitation was possible using the respective digital workflow to define harmony between a smile and facial tissues. Clinical significance: A digital treatment implant planning can be conducted considering patient\'s individual needs to improve the esthetic outcome.


Mohammed A Jafer, Majed A Hazazi, Majed H Mashi, Hassan A Sumayli, Ali YJ Mobarki, Alnomari Sultan, Maryam S Ali Hadi, Huthyfah Mohammed Abulqasim, Bandar Mohammed M Thubab, Shankargouda Patil

COVID-19 and Periodontitis: A Reality to Live with

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:6] [Pages No:1398 - 1403]

Keywords: Pandemic, Periodontitis,Coronavirus disease

PDF  |  DOI: 10.5005/jp-journals-10024-2961  |  Open Access |  How to cite  | 


Background: Coronavirus disease-19 (COVID-19) is a recent pandemic that is advancing at a rapid rate. The future course of the disease includes severe respiratory infection and also leads to death if unattended. Meticulous measures are necessary before attending any patient. The dental operatories and the clinic surroundings must be well sanitized so as to prevent the spread of pandemic. Aim and objective: This review discusses in brief about the pathophysiology and course of COVID-19. Further, we discussed in detail the management aspects of patients in periodontal perspective and the sanitization procedures required for the dental clinic. Review results: The SARS coronavirus enters the human circulation via the angiotensin-converting enzyme (ACE) receptors which are also found on the oral mucosal surfaces. Furin and Cathepsin L are the pro-inflammatory molecules released during pathogenesis of periodontitis and mediate the molecular pathways that help the virus invade into the host. The clinic set-up should be modified to best suit the pandemic conditions. This includes the three phases, i.e., phase I: preparatory phase; phase II: implementation phase; and phase III: follow-up. The patient management is explained based on the emergency needs of the patient based on the recent AAP classification of periodontal diseases and conditions 2017 as emergency, urgent, and elective treatment needs which have been explained in detail. Conclusion: It can be strongly concluded that there is direct relationship between oral health and systemic health. The treatment procedures and sanitization protocols must be definitely modified. Further consensus and systematic reviews help us arriving at a more standardized protocol. Clinical significance: This review would help clinicians modify the way they treat patients in the clinic and provide better services depending upon the emergency needs of the patient.


Ravishankar Krishna, Rashmi B Mandokar, Sweekriti Mishra, Karishma Jagadeesh, Suma Janya, Babashankara Alva

A Novel Functional Swallow Method to Establish the Posterior Palatal Seal during the Maxillary Edentulous Final Impression: A Case Report

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:4] [Pages No:1404 - 1407]

Keywords: Posterior palatal seal,Clinical technique, Complete dentures, Final impression, Functional swallow method, Maxillary complete denture, Maxillary denture retention

PDF  |  DOI: 10.5005/jp-journals-10024-2988  |  Open Access |  How to cite  | 


Aim and objective: To propose an alternate, reliable, and easy-to-use functional swallow method for establishing the posterior palatal seal. Background: Accurate registration of the posterior palatal seal is crucial to the success of the maxillary complete denture. The conventionally used functional “Ah” technique may not be reliable at times to record the posterior palatal seal, hence compromising the retention of the maxillary complete denture. Case description and technique: A 70-year-old female patient requiring complete dentures presented with an unusually tense soft palate during the phase of posterior palatal seal development. The soft palate did not relax and remained in a superior position when the “Ah” functional method was used to record the seal. The posterior palatal seal area could not be compressed sufficiently during border molding, preventing the formation of an adequate seal. Hence, a new functional technique was devised to relax and displace the soft palate for developing an effective seal. This case report describes a novel and reliable method of displacing the posterior palatal seal area with a low-fusing compound by utilizing the patient\'s functional swallow position. Conclusion: The functional swallow method can be used effectively as an alternative and reliable method to obtain a consistent posterior palatal seal. Clinical significance: The functional swallow method of developing the posterior palatal seal is simple, less demanding on the clinician, and can save chairside time. It also helps in an easy transfer of the demarcated posterior palatal seal area to the custom tray. The method lets the dentist be in charge of developing the seal rather than relying on the arbitrary cast scrapping by the technician. Also, the seal can be achieved by employing commonly used materials.


Adith Venugopal, Nikhilesh R Vaid

Interarch Traction Strategy for Palatal Cuspid Impactions

[Year:2020] [Month:December] [Volume:21] [Number:12] [Pages:4] [Pages No:1408 - 1411]

Keywords: Impacted canine, Interarch traction, Miniscrew, Modified power arm

PDF  |  DOI: 10.5005/jp-journals-10024-2972  |  Open Access |  How to cite  | 


Aim and objective: To disimpact a palatally impacted canine using a novel, compliance-dependent technique. Background: Orthodontic traction of palatally impacted teeth warrants careful mechanical strategies to avoid complications that include root damage to adjacent teeth and resorptions. Sound biomechanical control to avoid these side effects is considered paramount in planning the traction. Technique: The palatally impacted canine was pulled into the arch with the aid of a modified power arm on the exposed canine and a miniscrew on the lower arch. Conclusion: The impacted canine was successfully brought into occlusion within 11 months. Clinical significance: This paper highlights the use of a simple strategy using interarch mechanics and temporary anchorage devices (TADs) to aid in the safe mechanical eruption of impacted palatal canines without the need to bend complex wire designs.

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